Pain management · 2026
Rebound pain after patient-controlled epidural analgesia for major abdominal surgery : a retrospective study.
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Delbrouck Didier, Garcia Vincent, Leroux-Bromberg Nathalie, Leguilette Clémence, El Hajj Houssein
Аннотация
BACKGROUND: Rebound pain (RP) is recognized after locoregional analgesia, yet its incidence and determinants remain insufficiently characterized in major abdominal oncologic surgery patients managed with patient-controlled epidural analgesia (PCEA).
METHODS: We conducted a retrospective single-center study of patients undergoing major abdominal oncologic surgery with PCEA (n = 199). Maximal Daily Pain Scores (MDPS) were recorded during and after PCEA withdrawal. RP was defined as an increase of ≥3 points on the 11-point Numeric Rating Scale within 8 hours of discontinuation. Data on timing, modality, and prescriptions of systemic relay analgesics were collected. Descriptive, univariate, and multivariate logistic regression analyses evaluated risk factors for RP.
RESULTS: Of 199 patients, 92(46%) developed RP within 8 hours after PCEA withdrawal. Median PCEA duration was shorter in RP patients (93.3 h) compared with non-RP patients (112.5 h); p = 0.001, despite most receiving anticipatory relay prescriptions. Longer PCEA duration remained independently associated with a lower risk of RP in multivariate analysis (OR 0.81 per 12-hour increase; 95%CI,0.70-0.92; p = 0.002). The choice of relay analgesia was significantly associated with pain intensity during the two days before PCEA discontinuation, suggesting possible confounding by indication.
CONCLUSION: RP affected nearly half of patients after PCEA withdrawal. Extended PCEA duration significantly reduced its incidence.
METHODS: We conducted a retrospective single-center study of patients undergoing major abdominal oncologic surgery with PCEA (n = 199). Maximal Daily Pain Scores (MDPS) were recorded during and after PCEA withdrawal. RP was defined as an increase of ≥3 points on the 11-point Numeric Rating Scale within 8 hours of discontinuation. Data on timing, modality, and prescriptions of systemic relay analgesics were collected. Descriptive, univariate, and multivariate logistic regression analyses evaluated risk factors for RP.
RESULTS: Of 199 patients, 92(46%) developed RP within 8 hours after PCEA withdrawal. Median PCEA duration was shorter in RP patients (93.3 h) compared with non-RP patients (112.5 h); p = 0.001, despite most receiving anticipatory relay prescriptions. Longer PCEA duration remained independently associated with a lower risk of RP in multivariate analysis (OR 0.81 per 12-hour increase; 95%CI,0.70-0.92; p = 0.002). The choice of relay analgesia was significantly associated with pain intensity during the two days before PCEA discontinuation, suggesting possible confounding by indication.
CONCLUSION: RP affected nearly half of patients after PCEA withdrawal. Extended PCEA duration significantly reduced its incidence.